Demo CrescentCare Hospital: patient-to-cash day

Demo CrescentCare Hospital operates outpatient clinics, a 60-bed inpatient wing, an operating theatre, and a pharmacy. It serves self-pay patients, corporate contracts, and insurers in AED, while selected equipment and medicines are purchased in USD. OSERP links the non-clinical record: patient or sponsor account, appointment, admission, charge capture, stock issue, insurer claim, invoice, receipt, refund, and audit evidence. Clinical notes remain in the approved clinical system and are referenced by controlled identifiers rather than copied into general accounting screens.

1. Create the organisation and payer model

Set up legal company CCH, locations DXB-MAIN, DXB-CLINIC, and DXB-PHARM, departments for emergency, outpatient, inpatient, theatre, laboratory, pharmacy, finance, and insurance desk. Payers include Self Pay, Gulf Shield Insurance, corporate employers, and government programmes.

Master / field	Demo value	Impact
Patient ID	CCH-P-004281	Stable non-clinical account key
Payer	Gulf Shield Insurance	Claim and receivable owner
Coverage plan	Gold outpatient + inpatient	Tariff and authorisation rules
Service	MRI brain without contrast	Charge, price, tax, revenue
Pharmacy item	Ceftriaxone 1 g vial	Batch, expiry, issue traceability
Cost centre	Radiology	Department margin and budget
Pre-authorisation	GS-PA-88310	Prevents unapproved claim
Payment term	Insurer net 45	Ageing and cash forecast
Privacy class	Restricted health data	View, export, and retention rules

2. Register a patient and appointment

Open Patient Accounts → New and record patient ID, legal name, date of birth, nationality, contact, emergency contact, billing address, payer, policy number, and consent preference. Store identity documents in a restricted vault with document type, expiry, uploader, and access audit. Do not put diagnosis or sensitive clinical narrative in the customer master.

Create an appointment with specialty, provider, location, service, requested time, referral, payer, authorisation requirement, and status. A confirmation moves the appointment to scheduled; check-in records arrival time and identity verification. A no-show creates a policy-dependent fee or follow-up task, not an automatic charge unless the contract allows it.

3. Capture outpatient services

At check-out, the charge capture screen records patient, encounter reference, service code, quantity, tariff, discount, tax category, payer share, patient share, provider, department, and authorisation. For a consultation of AED 350 covered at 80%, insurer responsibility is AED 280 and patient responsibility AED 70.

The charge batch validates that the service was delivered, the provider is active, the tariff version was effective, and an authorisation exists where required. Rejected lines remain in an exception queue with reason and owner. Posting to the insurer subledger should not happen until the claim status supports billing.

4. Admit an inpatient and reserve resources

An admission header records patient, attending physician, ward, bed, admission date/time, expected discharge, payer, deposit, authorisation, and responsible contact. Bed status moves from available to reserved to occupied to cleaning to available. The resource history prevents two active admissions using one bed.

Daily room charges, nursing packages, meals, theatre, laboratory, and pharmacy issues are captured as charge lines linked to admission and cost centre. A deposit of AED 5,000 is recorded as patient advance or liability, not revenue. On discharge, the bill shows gross charges, insurer coverage, patient share, deposit applied, and balance due.

5. Issue medicines and consumables

The pharmacy receives medicines with batch, expiry, supplier, purchase order, quantity, UoM, temperature or quality status, and landed cost. A prescription or authorised issue requests Ceftriaxone batch CC240901B, 6 vials, from DXB-PHARM. The issue records patient/admission, batch, quantity, nurse or pharmacist, date, and return reason if unused.

OSERP applies FEFO and blocks expired, quarantined, or recalled batches. Inventory posting debits medical-consumables expense or patient cost and credits pharmacy inventory. A returned unopened vial reverses the issue; a wasted vial requires a waste reason and witness. The item cost flows to the admission or service dimension so finance can compare clinical revenue to consumable cost.

6. Submit an insurer claim

The insurance desk opens a claim batch for period, payer, facility, plan, currency, and source charge set. Claim lines include patient ID, policy number, authorisation, service code, date, quantity, tariff, discount, tax, payer share, and rejection code. A pre-submission validation checks eligibility on service date, duplicate claims, missing diagnosis or procedure code reference, authorisation limits, and provider credentials.

For an MRI charge of AED 1,200, the plan pays 90% and the patient pays AED 120. The claim stores billed AED 1,200, expected AED 1,080, patient share AED 120, and status submitted. A payer rejection must create an actionable reason such as invalid authorisation or exceeded limit. Correct and resubmit by referencing the original claim; never delete the rejected record.

7. Invoice, collect, and refund

When an insurer accepts the claim, create an invoice linked to claim batch and charge lines. The header records payer, service period, currency, due date, tax, branch, and contract. Posting debits insurer receivable and credits healthcare revenue, pharmacy revenue, room revenue, and tax according to dimensions. Self-pay balances are invoiced separately where policy requires.

Import insurer receipts with remittance reference, patient or claim identifiers, currency, value date, and amount. Allocate accepted lines and keep deductions as denial or dispute cases. A patient refund requires original receipt, reason, approval, bank details, and segregation from cashier posting. It reverses the advance or receivable and keeps the original payment visible.

8. Procurement, assets, and service contracts

The theatre requests a replacement monitor. A purchase request includes specification, department, budget, required date, supplier, asset class, and authorisation. The purchase order records warranty, calibration requirement, installation site, and service contract. Receipt records serial, acceptance test, calibration certificate, and custodian.

Capitalise the monitor only when placed in service. The asset record stores tag, useful life, depreciation, location, responsible department, warranty, and maintenance schedule. A service contract generates preventive work orders and invoices. Unplanned repair costs remain linked to the asset and department for lifecycle analysis.

9. Privacy, close, and measurable improvement

Health data requires minimum-necessary access, masked exports, retention schedule, and audit of views and downloads. Finance reports should use patient ID or encounter reference rather than diagnosis. Role separation prevents one user from registering a patient, approving a claim, receiving cash, and issuing a refund.

Month end reconciles appointments to charges, admissions to room days, pharmacy issues to inventory, claims to insurer receivables, deposits to liabilities, denials to disputes, payroll to departments, tax, and bank. Period locks prevent late service edits without an adjustment route.

KPI	Baseline	After OSERP discipline	Improvement
Claim first-pass acceptance	78%	94%	+16 points
Discharge-to-final-bill time	9 hours	90 minutes	83% faster
Unreconciled pharmacy issues	4.1%	0.6%	85% lower
Insurer remittance matching	71%	96%	+25 points
Patient refund cycle	12 days	3 days	75% faster
Restricted-data export incidents	6 / quarter	0	Controlled

Practice challenge

Register a patient, schedule an outpatient MRI, capture a payer split, issue a pharmacy item by batch, admit and discharge an inpatient, submit a claim with one rejection, resubmit it, collect the remittance, and reconcile the month. Explain every field, status, role, journal, tax, stock movement, privacy rule, and audit drill-down. Then attempt to issue an expired medicine and export a restricted report without permission; prove both controls work.

Related: Demo MedSure Distribution, Inventory, Procure to pay, Advanced GL Mapping, and API library.